Wednesday, January 30, 2008

Medical care for the elderly yields the least bang for the buck of any medical care.

Since it is only part of the market the program has little ability to control costs.

Free care for mothers and infants would make far more sense.

I believe that the program started because the medical establishment was taking to much of the inheritance of the American people but the program did not address the problem, it just shifted the payment to the tax paying population.

Study after study shows that medical care for the elderly has very little benefit for health. In fact some studies have shown medical care for the elderly to have a negative impact on life expectancy and quality of life (see the work of Robin Hanson). One study showed that people who choose hospice on average actually lived longer that those who chose more aggressive care.

If the US government was the sole buyer of medical care they would have some power to affect price. They could set price for procedures which might cause rationing but they could push prices down, but because Medicare is only about one third of the market they have to pay close to the market price.

Now if the politicians who enacted Medicare where truly interested in helping people the best bang for buck in healthcare is in care for mothers and infants. Care for mothers and infants can yield sizable benefits in quality life years.

So why did Medicare get enacted? I see two reasons. First there was a real problem in that people whose parents became too ill for them to care for would hand their parents off to the medical establishment who would treat them to a level that would put large cost burden on the families. Secondly the elderly reliably vote in large numbers and Most will consume medical care at some point. Young people (in the child bearing years) do not vote in large numbers and only a small percent need the care as most babies are born healthy.

And so we have Medicare and the medical establishment takes over people lives at the end and often does more harm than good.

A related story to show in real life an alternative to excessive care in late life

My mother (86 years old) has always had an attitude of trying to avoid doctors. For years we (the family) have tried to get her to go to regular doctors appointments. She resists saying that they always find something wrong. She will go if she is very sick. Once after much prodding she went to a doctor and asked about a symptom of having frequent bowel movements. She was diagnosed with Crohn's Disease. They gave her prescriptions for meds which she took for a while but the meds made her feel worse that the frequent bowel movements so she stopped taking them. Now she avoids certain foods and she says that the symptoms have lessened. She is now all the more determined to avoid doctors. After many years of trying to encourage her to get regular care I have begun to wonder if her way is not the better way. One thing that she fears is the medical establishment taking over her life at the end.

My mother has always said that doctors are fine if you have something that there is a cure for but there is no cure for the disease of old age. Some times it seems that it is better for old people to not know all the diseases that they have. If the symptoms can be treated great but the treatments should be balanced against the harm that they do.

From talking to my parents and their friends all that most old people care about is the expense. In fact once their health makes them unable to care for themselves they often prefer to die so they do not much care about the quality of care. Often it is family and the medical establishment that give them care that they do not want. That is why they strongly support medicare. It is not that they demand the care it is that they It back to the orgional problem they do not want the medical establishment to steal their money by giving them care that they do not want.